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PTA Blog Talk

Disagreeing with Discharge

Published May 1, 2014 8:47 PM by Jason Marketti

Disagreeing with someone is not something new for me. I will freely voice my opinion (usually supported with data and anecdotes) to anyone who will listen and objectively discuss an issue with me.

In the case of discharging a patient from therapy, the decision is ideally the PT's; however, as a patient advocate I have the responsibility to ensure patients receive the best care to maximize their potential. No health provider has a crystal ball to determine whether a patient will advance any further from his current functional status. There have been too many incidences where patients do progress and eventually go home when most providers had given up hope.

All clinical decisions should be based on educated evidence (and supported by data), not on whether a patient and family is liked or disliked. A decision to discharge a patient isn't necessarily about whether the patient will make progress in the future. It's about whether he is making progress today with therapy intervention and if that intervention so skilled, only a therapist is able to provide the care. If one wishes to debate a discharge, I'll be happy to quote CMS and state regulations and if a therapist doesn't like the rules, then he shouldn't play the game.

The phrase, "I'm the PT and I make the clinical decisions regarding patient care," means absolutely nothing to me when I'm the advocate and make a couple of calls to the ombudsman, state therapy board, and Office of Inspector General. I'll allow the experts to determine whether discharging a patient is equivalent to abandonment of care and I would love to see the data a therapist presents while trying to defend this.

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I agree that it is difficult to as a PTA to agree with decisions that you have no control over.  If there is a good PT to PTA relationship and good documentation to show that there is a skilled PT need and the patient is progressing still with possible discharge then your recommendations should not be an issue to where the team would argue against you.  In my setting the doctors and case management want to send everyone to either a SNF or and ARU setting when we recommend home they are constantly arguing with our recommendations and having doctors reorder physical therapy when the PT has already decided there is no skilled need in any setting or not in Acute care but maybe home health or outpatient, but at times we recommend SNF or ARU they are sent home many of which MD's don't listen to our recommendations and patient/family interference. We are stuck in a boat in our profession.  All we can do is document what we see and do and why we made those recommendations. Good Luck. Catherine Lucero P.T.A.

Catherine Lucero, Physical Therapy - P.T.A., Acute Care May 13, 2014 10:48 PM
Kingman AZ

I made it clear the decision to discharge is ideally the PT's.  Working in a SNF though it becomes a team decision based on nursing, social worker, MDS nurse, administrator, and which RUG level will be achieved by therapy.  Multiple factors are involved in discharging a patient.  Do they have a place to live, will they need further care, family involvement, finances, etc.  

As a PTA I can respect a PT's clinical decision making and will understand why they came to that decision.

As an advocate I have an opportunity to question their decision making and allow others to look at a discharge from an objective stand point.  

Indeed, if an investigation were to occur the relationship would be toxic, however, if the calls are not made who is going to protect the patients rights?  

Jason Marketti May 9, 2014 10:55 PM

Sounds like you should go to PT school. Love your drive and enthusiasm as a patient advocate. However, that is not your patient to determine DC, that is the PT's job.

The idea you will call the Board if a PT does not agree with your judgement sounds more like a fear tactic. I can only imagine the toxic relationship that would produce.

You start your Blog as a patient advocate, yet end it with threats.

Not sure how that is working for you. Best of luck.

Russ, PT May 9, 2014 9:16 AM

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About this Blog

    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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